CHILD ABUSE SYNDROME: THE "GRAY AREAS" IN ESTABLISHING A DIAGNOSIS

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Abstract
Despite almost universal legislation requiring physicians in the United States to report instances of suspected child abuse and in the face of published efforts to clarify and to define legal, medical, and social issues associated with the "batered child syndrome," some physicians find it hard to accept the reality of willful abuse of children. An attempt was made to explore further those situations in which the physician found it difficult to establish or rule out the diagnosis of child abuse. In each of the types of such cases, the major issues were the physician's subjective personal feelings, his misunderstandings of the Child Abuse Laws, or of his role and responsibilities. It is easy to comment that, if the physician understands that the Child Abuse Laws only make him responsible for reporting a case in which there is reasonable cause to suspect a case of abuse and if he understands that he is not responsible for establishing that the case is truly one of child abuse or for indentifying the abuser, then there would be few cases in the "gray area." It is not as easy to explain away or develop an approach to minimize the physicians' subjective feelings or personal views which confound his ability to establish this clinical impression. It is essential that all suspected instances of abuse be reported. Only then can community agencies become active to protect the child, to assist the family, and to interrupt the pattern of violent behavior.

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